Biomed, 
Lib. 
HV 
5733 
B751t 
1892 


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THE  LIBRARY 

OF 

THE  UNIVERSITY 

OF  CALIFORNIA 

LOS  ANGELES 


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TOBACCO, 


INSANITY .™  NERVOUSNESS. 


-BY- 


DR.  L.  BREMER, 


LATE     PHYSICIAN    TO    THE     ST.    VINCENT'S    INSTITUTION    FOR 
THE    INSANE,    OF     ST.    LOUIS,   MO. 


PRICE,    FIFTKEX    CE^^VTS, 


PUBLISHED  BY  THE 

MEYER    BROTHERS    DRUGGIST. 

ST.     LOUIS,     MO. 

1892. 


le  Contents  of  this  Pamphlet  are  based  on  an 
?le  read  before  the  St.  Louis  Medical  Society  in 
ber,  1891.     At  the  request  of  friends  and  per- 
interested  in  the  subject  the  author  has  agi 
large  and  modify  the  article,   and  to  publis 
?  present  form. 

L.  Bremer,  M.  D 
Louis,  December  22,  1891. 


ONES  PRINTING  CO..  2<  I  PINE   ST.,  ST.  LOUIS. 


T  t 


TOBACCO,  INSANITY  and  NERVOUSNESS 

BY 

DR.    L.    BREMER, 

OF    ST.    LOUIS. 


There  is  no  narcotic,  either  in  modern  or  ancient  times, 
which  has  been  and  still  is,  so  universally  in  use,  as  tobacco, 
And.  there- is  none  about  whose  action  on  the  human  body 
there  is  so  much  difference  of  opinion  among  the  laity  and 
the  profession. 

Whereas,  by  some,  it  is  looked  upon  as  an  im mitigated 
'  evil,  it  is  claimed  by  others,  that  its  use  is  not  without 
advantage.  Hence,  it  has  been  condemned  and  corn- 
amended  in  turns.  Its  friends  have,  so  far,  carried  the 
'  day;  its  triumphal  march  over  nearly  the  whole  civilized 
feand  uncivilized  orlobe  has  been  continuous. 

Without  entering  into  preliminaries  and  details,  I  will 
I  state  at  the  outset,  that  1  side  with  those  who,  looking  at 

>  the  injurious  effects  collectively,  consider  it  more  harmful 
i  than  alcohol,  from  the  simple  fact  that  its  use  is  more 
t  general,   its  effects  more   gradual    and    less  obvious,  and 

that,  from  a  moral  point  of  view,  it  is  in  better  standing. 
,      The  breath  of  tobacco   is  held  permissible  and  will  be 
[Condoned  by  all  classes  ;    that  of  alcohol  is  looked  upon 

as  odious  and  exposes  its  bearer  in  some  quarters  to  social 

>  ostracism. 

It  is  this  connivance,  on  the  part  of  public  opinion,  at 
this  land  of  luxus-consumption,  as  it  is  euphoniously  styled 

A  A  >#  r*  *~k  .- 


4  TOBACCO,    INSANITY    AND    NERVOUSNESS. 

by  modern  physiologists,  that  fosters  its  spread,  especially 
amongst  those  who  can  least  afford  to  offer  any  insult  to 
their  nervous  systems.  And  unfortunately  it  is  just  this 
class  of  persons  who  delude  themselves  into  the  belief,  that 
tobacco  is  indispensable  to  them.  With  advancing  civili- 
zation it  is  considered  necessary  by  many  to  use  a  sedative 
or  a  stimulant  of  some  sort  as  a  kind  of  a  safety-valve  for 
the  growing  nervousness  of  our  age. 

Thus,  by  many  smokers  it  is  thought  that  after  bodily 
or  mental  exertion  an  equilibrium  of  all  the  functions  is 
re-established  by  the  pipe,  cigar,  or  plug.  Its  action,, 
therefore,  is  somewhat  like  that  of  coca  *  in  its  pleasant 
effects, 

This  is  the  case  in  the  healthy  smoker  as  long  as  he  keeps 
within  certain  limits.  But  it  is  quite  different  with  the 
vast  and  ever-increasing  army  of  neurasthenics  and  psycho- 
paths of  our  days. 

Our  ancestors  were  evidently  not  so  deleteriously 
affected  either  by  alcohol  or  tobacco,  as  modern  man  is,, 
with  the  strain  of  the  requirements  of  a  more  complicated 
life  weighting  upon  him,  and  handicapped,  as  he  frequently 
is,  in  his  nervous  and  psychical  make-up. 

It  is  specially  of  the  effect  of  tobacco  on  this  latter  class 
that  I  wish  to  speak  in  the  following  remarks,  and  to  start 
with,    I   venture   the    broad    assertion,    that,   whereas  the 

*  The  pernicious  influence  of  this  drug  is  also  spreading  at  an  alarm- 
ing pace  among  the  well-to-do.  The  various  proprietary  preparations 
which  go  by  the  name  of  '«  Wine  of  Coca  "  and  which,  to  the  detriment 
of  many,  have  been  indorsed  by  physicians  in  good  standing,  are  con- 
stantly working  havoc  among  neurotic  persons  who  believe  they  can  take 
this  kind  of  wine  with  the  same  impunity  as  they  can  alcohol  in  some 
form.  Only  too  late  they  find  that  one  tablespoonful  of  the  stuff  calls 
for  another  and  that  a  constant  vague,  half-conscious  feeling  of  misery 
pushes  them  with  the  relentlessness  of  fate  to  the  baneful  bottle.  Why 
do  not  the  physicians,  if  coca  is  indicated,  use  the  reliable  fluid  extract 
and  have  it  taken  in  Madeira  wine  instead  of  v^iUg  and  abetting  a  nefa- 
rious traffic,  which  they  do  by  prescribing  rietary  wines  of  coca? 


TOBACCO,    INSANITY    AND    NERVOUSNESS.  0 

and  healthy,  especially  if   he  lead  an  active  outdoor 

b,*  may  use     jbacco  in  its  various  forms  with  apparent 

ity,    t.    e       without    experiencing  any  demonstrable 

*o    holy    or     mind,    the    neurasthenic    and    the 

^ath  ha^e  no  business  either  to  smoke  or  chew.t 

it  is  just  persons  of  this  category  (who  are  often  not 

I  aware  of  their  morbid  condition)  that    become  such 

1   i  owerless   slaves    to    the   habit.      They    fall 

.rly  in  life  as  a  rule.     Whilst  the  healthy 

1  revolts  against  the  drug  as   intensely  as 

a  cat,  and  has  to  gradually  accustom  itself 

ove  e  unpleasant  sensations  accompanying  the 

■at  attempts  i    using  it,  the  born  neurasthenic  often  takes 

it  as  the  yoi   lg  duck  does  to  water.     Only  in  this  manner 

i]    the    pecu    xr     phenomenon     of     infant-smokers     be 

e  does  not  prefer  to  look  upon  such  per- 

ite  as  a  species  of  precocious  moral  insanity 

herited  from  parents  who  are  generally  not  only  excessive 

-users,  I  ut  evidently  mentally  defective. 

.  I  do  n  >t  believe   that,  with  approaching  maturer 

I  am  one    f  those  who  eye  through  pessimistic  specta- 

risins;     deration,  but  I  simply  repeat  the  every-day 

ch  I  have  never   seen  doubted  or  cont ra- 


te  eliminate  nicotine   so   quickly  as  muscular  ex- 
: 

X  It  is  strange  am    would  be  amusing  to  the  observer,  were  it  not  such 

ter,  to  see  the  delusion  on  the  part  of  many  young  neuras- 

;s  who  imagine  that  they  have  a  great  deal  of  nerve  force.     It  is 

.  3    ung  man  that  he  has  a  deranged  stomach. or  kidney, 

oms  are  present;  but  a  statement  that  his  nerves 

ad  brain  are  Helow  par,   and  that  tobacco  is  rank  poison  to  him,  is 

jceived  with  more    r  less  incredulity.     Thus,  a  young  man,  a  patient  of 

line,  knew  that  on  various  occasions,  after  excesses  in  smoking,  he  had 

_>f  a  grave  and  pronounced  character.    Yet  he  consid- 

>ng,   because  he   was  energetic;    after  periods  of 

bstinence  •■     woul.     iudulg 

Lways  with  the  ^ame  result. 


b  TOBACCO,    INSANITY    AND    NERVOUSNESS. 

dieted,  that  there  is  an  alarming  increase  of  juvenile  smok- 
ers; and,  basing  my  assertion  on  the  experience,  gathered 
in  my  private  practice  and  at  the  St.  Vincent's  Institution 
of  this  city,  I  will  broadly  state  that  the  boy  who  smokes 

AT  SEVEN,  WILL  DRINK  WHISKEY  AT  FOURTEEN,  TAKE  TO 
MORPHINE  AT  20  OR  25,  AND  WIND  UP  WITH  COCAINE  AND 
THE  REST  OF  THE  NARCOTICS,  AT  30  AND  LATER  ON. 

It  is  like  a  pathologico-moral  version  of  Hogarth's  "  The 
Rake's  Progress." 

It  may  look  like  overstating  and  exaggerating  things > 
but  I  know  whereof  I  speak,  when  I  say  that  tobacco  when 
habitually  used  by  the  young  leads -to  a  species  of  imbecil- 
ity ;  that  the  juvenile  smoker  will  lie,  cheat  and  steal,, 
which  he  would  not,  had  he  let  tobacco  alone.  This  kind 
of  insanity  I  have  observed  in  quite  a  number  of  cases  at  the 
St.  Vincent's.  The  patients  presented  all  the  characteristics 
of  young  incorrigibles.  They  had  exhausted  the  indul- 
gence of  their  parents,  who  saw  no  other  way  to  protect 
them  from  their  insane  pranks,  than  to  commit  them  to 
the  institution.  Had  they  been  less  favorably  situated 
financially,  they  would  have  landed  at  the  House  of~Cbrrec- 
tion  or  the  Workhouse. 

I  do  not  know  whether  a  lasting  improvement  was 
effected  in  any  of  them.  There  was  not  one  amongst  them 
that  was  able  to  comprehend  that  tobacco  was  injuring  him  ; 
they  were  constantly  on  the  lookout  for  obtaining  it,  by 
begging,  stealing  or  bribing,  and  regarded  the  deprivation 
of  the  drug  as  a  punishment.  The  sense  of  propriety,  the 
faculty  of  distinguishing  between  right  and  wrong,  was  lost. 
The  father  of  one  of  thenf  who  looked  upon  Iris  son  only 
as  an  aggravated  case  of  bad  boy,  told  me  that  he.. himself 
had  been  smoking. -ever'  since  his  10th  year  and  it  never  had 
affected  him.  Iiureality,  being  only  45  years  old,  he  was 
a  wreck,  physically  and  mentally,  though  he  came  of 
healthy    stock,     tie  could  not  or  would  not  comprehend 

,  4 


TOBACCO,    INSANITY    AND    NERVOUSNESS.  7 

that  tobacco  was  gradually  undermining  his  own  mind 
and  body,  although  his  wife  and  his  friends  knew  and 
saw  it. 

But  it  is  not  only  in  the  young,  that  the  use  of  tobacco  is 
followed  with  such  disastrous  effects.  Smoking  or  chew- 
ing,  when  commenced  in  the  period  of  manhood,  and  even 
at  the  time  it  generally  does  least  harm,  after  middle  age, 
will  tell  on  the  mind  if  excessively  indulged  in.  Is  it  to  be 
wondered  at,  that  a  drug  which,  until  tolerance  is  estab- 
lished, has  such  potent  and  palpable  effects  as  to  produce 
loss  of  co-ordination  and  unspeakable  malaise,  and  after  the 
organism  has  become  used  to  it,  is  capable  of  setting  up 
the  well-known  heart  disturbances,  amblyopia  and  even 
amaurosis  —  which,  in  short,  possesses  the  characteristic 
qualities  of  a  powerful  nerve  poison,  is  it  a  wonder  if  such 
drug,  when,  in  spite'of  the  warnings  on  the  part  of  various 
organs,  excessively  and  persistently  used,  finally  produces 
one  or  the  other  form  of  insanity?  A  drug  that  can,  as 
has  been  demonstrated,  cause  organic  changes  of  the  optic 
nerve,  wThich,  I  hardly  need  mention  it,  is,  in  reality,  not 
a  nerve,  but  a  protrusion  of  elongation  of  the  brain  itself 
must  certainly  be  capable  of  injuriously  influencing 
other  and  functionally  higher,  parts  of  the  organ  of  the 
mind. 

Dr.  Kjelberg  read  before  the  section  of  Neurology  and 
Psychiatry  of  the  last  International  Congress,  a  paper  in 
which  he  described  a  nicotine-psychosis,  well  marked  by  def- 
inite symptoms  and  stages.  I  have  never  seen  the  clinical 
picture  as  drawn  by  this  observer,  but  it  always  seemed 
to  me  that  whenever  tobacco  entered  at  all  as  a  factor  in  a 
case  of  insanity,  it  was  the  immediate  cause,  vivifying, 
uniting  and  condensing,  as  it  were,  the  dormant  morbid 
elements  which  predisposed  the  individual  to  mental  dis- 
turbance. Thus  I  have  seen  melancholia,  more  often 
mania,  and  very  frequently  general  paresis  hastened  and 


8  TOBACCO,    INSANITY   AND    NERVOUSNESS. 

precipitated  by  excessive  use  of  tobacco.  I  know,  however, 
of  instances  where  the  last  named  disease,  or  "  softening 
of  the  brain,"  as  it  is  called  by  the  lay-public,  could  not  be 
referred  to  any  other  cause  but  tobacco. 

That  the  majority  of  the  insane  smoke  or  chew  is  too 
well  known  to  deserve  special  mention.  Some  alienists 
have  been  of  the  opinion  that  this  habit  ought  not  to  be 
discouraged,  that  it  has  a  calming  and  pacifying  effect 
especially  on  the  chronic  insane.  I  believe  this  to  be  the 
case  in  some  of  the  secondary  dements,  but  ordinarily, 
though  calming  at  first,  it  has  an  exciting  effect  later  on. 
True,  if  the  temporary  contentment  resulting  from  the 
gratification  of  the  craving  of  the  patient  is  looked  upon  as 
the  action  of  tobacco,  I  agree  that  its  effects  are  calming. 
But  this  quieting  down,  in  my  opinion,  takes  place  on  the 
same  principle  that  a  child  gets  quiet  and  stops  crying  when 
its  wish,  even  though  most  unreasonable,  is  gratified.  The 
rule  is,  that  smoking  causes  or  prolongs  excitement  in  the 
insane.  Many  become  absolutely  unmanageable  as  soon  as 
they  touch  tobacco.  They  get  quarrelsome,  tease  and 
molest  their  fellow-patients  and  render  themselves  obnox- 
ious generally. 

That  tobacco  really  does  cause  insanity  is  evidenced  by 
the  magic  effect  seen  in  some  cases  after  the  discontinu- 
ance of  the  drug,  when  the  patient's  condition  is  still 
such  that  he  is  not  wholly  inaccessible  to  reason  and  has 
will  power  enough  to  abandon  the  habit.  Thus  I  have 
seen  that  beginning  melancholia  with  suicidal  impulses, 
hallucinations  of  various  kinds,  forced  actions,  besides,  the 
precursory  symptoms  of  insanity,  such  as  insomnia,  crying 
spells,  praecordial  anxiety,  fears  of  impending  evil,  "  that 
something  is  going  to  happen,"  impotency,  vertigo,  begin- 
ning impairment  of  memory  and  judging  power,  and  even 
the  lowering  of  the  moral  tone,  all  of  which,  and  a  host  of 
other  symptoms   were    attributable     to    chronic    tobacco- 


TOBACCO,    INSANITY    AND    NERVOUSNESS.  V 

intoxication,  disappeared  after  freedom  from  the  habit  was 
established.* 

But  whenever  a  case  has  gotten  so  far,  that  commitment 
to  an  institution  has  become  necessary,  the  prospects  are 
not  so  good,  because  such  persons,  as  a  rule,  cannot  be 
convinced  that  tobacco  is,  or  has  been,  the  cause  of  their 
mental  trouble.  Their  argument  is  that  almost  everybody 
smokes,  that  all  their  friends  and  acquaintances  chew  or 
vSmoke,  without  showing  any  symptoms  of  insanity. I     The 

*  One  of  my  patients  experienced  among  other  morbid  symptoms  an 
almost  uncontrollable  desire  to  throw  himself  out  of  the  window,  when- 
ever he  had  to  go  to  the  upper  stories  of  the  house  in  which  he  was 
employed;  this  impulse  was  so  overpowering  that  he  did  not  dare  to 
approach  the  windows  and  was  in  mortal  fear  of  high  places.  He  was 
a  smoker  and  a  neurasthenic.  The  discontinuance  of  the  drug  termin- 
ated his  morbid  impulses  and  fear. 

X  This  is  an  argument  which  it  is  hard  to  invalidate,  because  the  smoker 
does  not  appreciate  the  law  of  difference  and  variability  of  the  resist- 
ing power  on  the  part  of  the  organism,  although  this  law  is  a  matter  of 
every-day  observation.  While  some  persons  seem  to  be  proof  against 
almost  any  injurious  agencies,  others  will  yield  on  the  slightest  occasion, 
to  much  less  powerful  influences,  mechanical,  toxic,  or  morbific  in  the 
stricter  sense.  Again,  the  susceptibility  to  injury  varies  in  the  same 
individual.  What  is  true  of  individuals  applies  with  equal  force  to 
nations.  Thus,  the  Germans  have  been  called  a  nation  of  thinkers  and 
smokers,  and,  seemingly,  their  smoking  habits  have  not  interfered  with 
their  power  for  logic,  nor,  for  that  matter,  [except  a  generally  pfevaling 
short-sightedness]  with  their  physical  constitution.  This  has,  for  a  long 
time,  puzzled  the  French,  who  have  tried  to  account  for  the  dire  effects  of 
tobacco  on  their  own  countrymen  in  various  ways.  Some  investigators 
think  this  difference  in  effect  is  due  to  the  difference  in  the  manner  of 
raising  tobacco  in  the  two  countries,  and  the  different  percentage  of 
nicotine  thus  obtained.  The  Germans,  on  the  other  hand,  are  dumb- 
founded at  the  amouut  of  alcohol  which  the  Russian  consumes  appar- 
ently  without  injury. 

This  discrepancy,  in  effect,  is  certainly  not  a  matter  of  difference  in 
quality.  As  remarked  before,  all  this  is  a  question  of  resisting  power 
produced  and  governed  by  racial,  social,  climatic,  industrial  and  a  num- 
ber of  other  more  or  less  occult  influences.  Now,  all  observers  agree 
that  in  our  country  many  conditions  conspire  to  make  us  a  nervous  peo- 
ple, to  produce   what  has  even  been  styled,  ."  American   nervousness." 


10  TOBACCO,    INSANITY    AND    NERVOUSNESS. 

alcoholic  insane  when  leaving  the  institution  to  enter  active 
life  again,  generally  knows  and  admits  that  alcohol  has 
been  the  cause  of  his  mental  break-down,  the  nicotine-vic- 
tim does  not  admit  anything. 

There  has  been  a  movement  on  foot  in  the  medical  press, 
and  to  some  extent  in  the  daily  papers,  which  latter 
chronicle  the  few  cases  that  come  to  public  knowledge 
under  the  head:  "  Gone  insane  from  cigarette-smoking, "* 
etc.,  to  counteract  the  spread  of  this  fatal  habit,  fatal  to 
the  individual  himself  and  pernicious  to  the  coming  genera- 
tion ;  but  so  far,  apparently  without  any  appreciable 
result. 

French  medical  observers  are  of  the  opinion  that  one  of 

This  "  nervousness  "  in  other  words  means  a  weakness,  an  instability,  a 
vulnerability  of  the  nervous  system.  Add  to  this  the  unquestionably 
stroug  quality  of  the  tobacco  which  the  taste  of  the  American  public 
exacts  from  the  manufacturer,  and  it  becomes  plain  that  there  exist  two 
cogent  reasons  why  we  should  be  on  our  guard  vis-a-vis  the  indiscrimi- 
nate use  of  the  article. 

*  Whether  there  is  a  constituent  in  the  cigarette  endowed  with  special 
properties  as  a  nerve  and  brain-poison,  I  have  not  been  able  to  ascertain. 
My  friend,  Dr.  J.  C.  Mulhall,  of  this  city,  in  a  paper  read  before  the 
Medico-Chirurgical  Society  several  years  ago,  claimed  that  it  was  the 
cheapness  and  easy  acquisition  of  the  article  and  consequently  its  un- 
bounded consumption,  that  rendered  it  so  pernicious,  especially  to  the 
young,  and  that  its  contents  differed  in  no  way  from  other  tobacco.  I 
have  no  doubt  that  pecuniary  considerations  and  the  temptation  to  fill 
the  little  scraps  of  time  with  smoking  contribute  largely  to  the  lamentable 
effects  of  cigarette  consumption :  but  the  result  of  my  inquiries  among 
former  victims  of  the  cigarette  habit  leads  me  to  believe  that  the  action 
of  cigarette  smoke'  on  the  nervous  system  is  totally  different  from  that 
of  the  cigar.  I  hope  for  the  sake  of  humanity  that  the  charge  so  often 
made  that  opium  is  used  in  cigarette  manufacturing  cannot  be  substan- 
tiated. If  true,  it  would  constitute  the  lowest  depth  of  commercial 
infamy.  However  this  may  be,  one  thing  seems  to  be  generally  con- 
ceded, that  is  the  well-nigh  universal  habit  of  cigarette  smokers  to 
"inhale"  and  thus  to  multiply  the  chances  of  nicotine-absorption. 
Possibly  it  is  on  this  account  that  moral  and  intellectual  blight  befalls  so 
oft,en  the  juvenile  habitue  and  that  the  adult  victim  in  time  becomes 
fidgety  and  cranky,  sometimes  barely  able  to  move  along  the  narrow  strip 
of  the  borderland  of  insanity. 


TOBACCO,    INSANITY    AND    NERVOUSNESS.  11 

the  factors  causing  the  depopulation  of  France  is  the  ex- 
cessive use  of  tobacco  by  its  inhabitants;  for  the  offspring 
of  inveterate  tobacco  consumers  is  notoriously  puny  and 
Stunted  in  stature  and  lacks  the  normal  power  of  resist- 
ance, especially  on  the  part  of  the  nervous  system  ;  again, 
in  our  country  it  is  a  significant  fact  that  an  astounding 
percentage  of  the  candidates  for  admission  to  \Ve*t  Point 
and  other  military  schools  are  rejected  on  account  of 
tobacco-hearts  ;  from  all  countries  and  from  all  classes  of 
society  come  reports  in  increasing  numbers  of  the  baneful 
effects  of  the  tobacco-habit. 

But  the  consumption  goes  on  and  will  do  so,  until  an  exam- 
ple is  set  by  those  who,  above  all  others,  can  estimate  the 
disastrous  effect  of  the  habit. 

If  teachers,  preachers  and  physicians  would  pronounce 
the  anathema  on  tobacco  and  abstain  from  it  themselves, 
others  would  follow.  But  here  is  the  difficulty.  It  is  only 
exceptionally  that  a  smoking  pedagogue,  clergyman  or 
physician  can  be  convinced  that  he  would  be  a  better  man 
physically,  intellectually  and  morally,  if  he  would  give  up 
tobacco,  and  that  he  has  no  idea  what  capabilities  of  well- 
being  he  possesses,  if  he  only  could  muster  up  moral  cour- 
age enough  to  abandon  the  use  of  a  drug  which  in  nine 
cases  out  of  ten  produces,  to  say  the  least,  a  vague  sensa- 
tion of  uneasiness  and  restlessness,  which  only  too  often 
calls  for  a  remedy  that  will  do  away  with  these  effects,  and 
that  is  alcohol.  Some  are  aware  that  tobacco  alone  is 
responsible  for  a  continual  malaise  or  misery,  especially 
when  their  attention  is  called  to  it  by  others,  but  like  the 
cocainist,  who  asserts  that  the  effects  of  cocaine  are  horrible, 
and  still  goes  on,  using  the  poison,  so  the  tobacco-slave  is 
bound,  as  by  fate,  to  again  indulge  in  a  drug  which  he 
knows  causes  him  to  suffer.* 

*  It  must  be  a  strangely  potent  fascination  indeed,  which  tobacco  exer- 
cises over  the  bulk  of  its  victims,  when  we  consider  that  some  are  aware 


12  TOBACCO,    INSANITY    AND    NERVOUSNESS. 

Some,  however,  labor  under  the  delusion  that  it  increases 
their  working  power,  that  the  flow  of  thought  becomes 
easier,  and  that  without  tobacco  they  are  unable  to  do  any 
mental  work.  Instances  are  cited  by  them  of  great  men, 
inveterate  and  excessive  tobacco  consumers,  who  left  their 
mark  in  the  history  of  civilization  as  savants,  artists,  etc. 
They  do  not  consider  the  possibility  that  these  men  accom- 
plished what  they  did  in  spite,  but  not  in  consequence  of, 
or  aided  by,  their  habit. 

Students  of  chronic  nicotine-intoxication  are  convinced 
that  the  great  men  among  the  tobacco  slaves  would  have 
been  still  greater,  had  they  never  used  the  drug.  Thus, 
Kant,  the  most  eminent  of  German  philosophers,  is  said  to 
have  written  such  an  obscure  and  unintelligible  style,  be- 
cause he  smoked  and  snuffed  to  excess.  I  myself  know 
of  a  medical  man  who  wrote  a  great  book,  which  labors 
under  the  same  defect  as  Kant's  works,  because  of  his 
slavery  to  tobacco. 

But  these  things  are  trifles  when  compared  with  the  de- 
structive and  degenerative  influences  the  drug  exerts  on 
the  broad  masses. 

that  tobacco  is  at  the  bottom  of  all  their  ailments.  The  question 
naturally  arises  in  this  connection:  why  do  people  smoke,  when  they 
know  that  as  soon  as  they  touch  tobacco,  they  experience  immediately  its 
toxic  effects?  Many  a  smoker  rises  in  the  morning  bright  and  energetic : 
the  nicotine  absorbed  during  the  previous  day  has  been  eliminated  from 
his  tissues  —  thanks  to  his  well-meaning  and  powerful  excretory  organs. 
He  smokes  his  first  cigar  after  breakfast,  becomes  at  once  restless,  dis- 
satisfied, peevish  and  disagreeable;  the  cigar  stamps  its  siguatureon  his 
mind  for  the  rest  of  the  day.  This  is  the  experience  of  many  a  neurotic 
smoker,  and  yet  he  will  resume  the  practice  clay  after  day,  making  his 
own  life  a  burden  and  rendering  everybody  around  him  miserable.  It  is 
easily  intelligible  why  some  persons  take  alcohol:  this  is  primarily  a  stimu- 
lant and  secondarily  a  paralyzant,  but  tobacco  paralyzes  at  once :  it 
lowers  all  the  faculties  except  those  of  fancy,  and  tobacco-phantoms  are 
not  of  much  value.  The  downfall  and  general  backwardness  in  civiliza- 
tion so  characteristic  in  the  Oriental  people  is  largely  due  to  their 
dreamy  disposition  engendered  by  abuse  of  tobacco. 


TOBACCO,    INSANITY    AND    NERVOUSNESS.  13 

There  is  only  one  way  to  lessen  the  evil  —  it  is  the  dis- 
semination of  knowledge  of  the  baleful  effects  of  tobacco 
among  the  rising  generation,  initiated  and  sustained  by  the 
three  professions  mentioned  above.  Of  course  they  ought 
practice  first,  what  they  are  going  to  preach. 

But  is  there  much  prospect  of  such  a  movement  at  pres- 
ent? I  think  not.  I  know  of  schools  conducted  by  the 
clergy,  in  which  smoking  is  not  only  permitted  to  fourteen 
years  old  —  and  even  younger  boys  —  but  more  or  less 
encouraged.  I  believe  that  its  well  known  anaphrodisiac 
effect,  on  account  of  which  it  was  very  popular  among  the 
monks  of  Italy,  several  centuries  ago,  is  possibly  a  reason 
for  the  favor  in  which  it  is  held  at  the  present  day  in  some 
quarters. 

Again,  I  know  of  physicians  who  not  only  smoke  to  ex- 
cess themselves  or  still  worse,  indulge  to  a  morbid  extent 
in  the  unmannerly  habit  of  chewing,  but  permit  and  even 
encourage  their  own  children  to  smoke.  One  of  them  was 
in  the  habit  of  awarding  his  13-year-old  son  by  extra-good, 
i.  e!9  extra-strong  cigars  for  high  numbers  in  school.  It  is 
hardly  necessary  to  add  what  became  of  this  boy.  He  is 
now  a  periodical  inmate  at  various  sanitariums  for  a  com- 
bination of  bad  habits. 

And  the  teachers?  They  are  not  lagging  behind  in  con- 
tributing to  the  army  of  tobacco  slaves ;  there  are  few  that 
raise  their  voices  against  the  habit,  for  the  very  valid 
reason  that  they  are  not  fully  cognizant  of  its  evil  effects 
and  smoke  as  much  themselves  as  men  in  other  vocations. 

In  view  of  such  discouraging  facts  I  hardly  expect  much 
good  from  this  contribution  and  testimonial  to  the  perni- 
cious effects  of  tobacco,  because  the  truth  has  not  dawned 
upon  the  multitude  yet.  As  in  the  body  politic,  evils  will 
run  their  course,  until  there  is  a  general  uprising  of  com- 
mon sense  which  disposes  of  them,  so  with  the  irrational 
and  excessive  use  of  tobacco,    which   will    probably  go  on 


14  TOBACCO,    INSANITY    AND    NERVOUSNESS. 

increasingly,  until  a  limit  of  endurance  is  reached,  and  the 
disastrous  results  of  the  abuse  become  patent  enough  to 
impress  even  the  dullest  mind. 

But  under  existing  conditions  the  habit  will  not  want  for 
new  generations  of  victims,  as  long  as  the  cigar  is  looked 
upon  as  a  symbol  of  manliness  by  the  young,  and  the  pipe 
as  that  of  peace  and  comfort  by  the  adult,  and  as  long  as 
tobacco  is  praised  in  word  and  picture.  To  what  extent 
the  habit  is  fostered  among  boys  on  the  theory  of  forbidden 
fruit,  it  is  not  my  province  to  discuss. 

This  paper  was  designed  to  bring  before  this  Society 
and  the  profession  at  large  my  views  on  a  subject  with 
which  unusual  opportunities  have  made  me  familiar.  Im- 
perceptibly I  have  drifted  from  the  role  of  the  author  of  a 
paper  into  that  of  a  moralist  and  exhorter,  and  yet  I  know 
what  an  unpopulur  figure  the  man  cuts  that  has  the  slightest 
suspicion  of  a  reformer  about  him.  My  consolation  is  that 
I  foresee  the  results  of  these  remarks  on  my  readers.  One 
will  say  with  a  pitying  smile:   All  true,  but  exaggerated. 

Another  one  who  reads  this  will  be  convinced  of  the  cor- 
rectness of  some  points  as  applying  to  his  own  case.  He 
will  fling  his  freshly-lit  cigar  away  with  the  firm  resolve  of 
quitting  the  weed  forever.  The  effect  is  immediate.  In  a 
few  days  he  feels  that  his  mental  and  physical  energies  are 
wonderfully  strengthened ;  there  is  a  buoyancy  of  spirits, 
a  return  of  healthy  animal  life,  which  he  has  not  expe- 
rienced for  many  a  year  and,  one  fine  day,  when  he  feels 
particularly  bright  and  happy  over  so  wonderful  a  change, 
he  celebrates  the  event  and  —  lights  another  cigar.  The 
Angel  of  Constancy  veils  his  face,  and  the  same  train  of 
the  old  familiar  symptoms  of  neurasthenia  and  mental 
depression,  of  irritability  and  don't-know-what's-the-mat- 
ter-feeling  take  a  renewed  and  firmer  hold  of  him. 

So  I  fear  I  shall  share  the  fate  of  the  preacher  in  the 
desert. 


TOBACCO,    INSANITY    AND    NERVOUSNESS.  15 

But  may  be,  that  one  or  the  other  tobacco-user  comes  to 
the  conclusion  that  he  shows  some  of  the  symptoms 
detailed  above  himself,  and  that  he  resolves  to  quit  ;  is 
there,  in  this  case,  any  danger  in  the  abrupt  discontin- 
uance of  the  drug,  as  there  is  in  quitting  the  habitual  use 
of  alcohol  or  morphine,  for  instance? 

My  experience  is  that  there  is  none.  By  "  tapering  off  " 
the  combat  would  be  unnecessarily  prolonged. 

It  is  not  well  to  make  a  compromise  for  him,  who  has 
already  begun  to  suffer  from  outspoken  toxic  effects  of  nico- 
tine, and  to  simply  decrease  the  daily  allowance  of  tobacco. 
Many  a  smoker  is  astonished  to  hear  from  his  physician 
that  even  the  two  or  three  cigars  he  is  smoking  now,  keep 
him  in  the  wretched  state  he  complains  of,  when  a  dozen 
and  more  in  former  years  did  not  affect  him. 

The  explanation  of  this  paradox  is  very  simple.  Through 
chronic  poisoning,  or  a  long  series  of  acute  and  sub-acute 
attacks  of  nicotine  intoxication  he  has  lost  all  resisting 
power  and,  like  the  broken-down  alcoholic,  who  used  to 
drink  a  quart  or  more  of  whisky  a  day,  and,  when  his  nerves 
are  shattered  by  the  abuse  gets  pathologically  drunk  and 
fuddled  on  one  ounce,  so  the  nicotine-invalid  is  completely 
unnerved  by  one  or  two  cigars. 

A  stumbling-block  to  good  resolutions  proves  often  the 
following  mistake  which  is  quite  prevalent:  Many  smokers 
who  are  told  that  tobacco  is  at  the  bottom  of  their  ailment 
and  who  finally  believe  it  and  act  on  this  belief,  expect  that 
with  abolishing  the  cause,  the  effect  will  cease  immediately, 
that  they  will  jump  with  both  feet  into  perfect  health  on 
quitting  tobacco.  They  do  not  consider  that  the  mischief 
done  by  a  chronic  disease  of  any  kind  to  the  organism,  it 
takes  months,  nay,  years,  to  undo  by  strict  hygienic  living. 
Tobacco-cachexia  in  its  various  forms,  is  no  exception  to 
the  rule. 

Lastly:    Are  there  means  by  which  the  abandoning  of 

4-1 1 RCH 


16  TOBACCO,    INSANITY    AND    NERVOUSNESS. 

the  drug  may  be  facilitated  ?  Yes.  But  of  paramount  im- 
portance is  the  firm  resolution  to  quit.  This  being  settled, 
a  combination  of  the  bromides,  Indian  hemp  and  bitter 
tonics  will  easily  tide  the  patient  over  the  gnawing  sensa- 
tion and  general  uneasiness  of   the  tobacco-hunger. 


UNIVERSITY  OF  CALIFORNIA  LIBRARY 

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